Presentation on theme: "The Patient’s View Lecture 7 Medicine, Disease and Society in Britain, 1750 - 1950."— Presentation transcript:
The Patient’s View Lecture 7 Medicine, Disease and Society in Britain, 1750 - 1950
Lecture Themes and Outline Disappearing voice of the patient? 1. Why is it important ? Roy Porter’s view 2. Sources: Diaries, Correspondence, Oral Histories 3. The experience of being ill 4. Lay care 5. Relationship between the patient and the practitioner
Raphael Samuel (1934-1996) Samuel was a Marxist historian and professor of history at the University of East London. Became a member of the Communist Party Historians Group, along with Christopher Hill, E. P. Thompson and others. He co-founded the journal, Past and Present in 1952, and pioneered the study of working-class history. He founded the History Workshop movement at Ruskin College, Oxford in the late 1960s.
Roy Porter, ‘The Patient’s View: Doing Medical History from Below’(1985) It takes ‘two to make a medical encounter - the sick person as well as the doctor...Indeed it often takes many more than two, because medical events have frequently been complex social rituals involving family and community as well as sufferers and physicians. Moreover a great deal of healing in the past has involved practitioners only marginally, or not at all, and has been primarily a tale of medical self-help, or community care.’ (p.175)
1. The Experience of Illness ‘We need to question medical history's preoccupying concern with cures (even cures that don't work). It is modern medicine that is cure-fixated. Pharmaceutical intervention in the past, by contrast, paid great attention to pain control, to fortifying the body, to adjusting the whole constitution. And treatment went far beyond drug interventions, involving complex rituals of comfort and condolence, the consolations of philosophy and grit, acted out by the suffering, with the physician sometimes sharing in the psychodynamics of the bedside encounter’.
2. Keeping Well ‘Our ancestors were at least as concerned with positive health, and with routine health maintenance, as with sickness, with prevention rather than merely therapeutics.’ ‘We commit gross historical distortions if we fail to give due weight and attention to traditional medical interest in the weather, in diet, in exercise, in sleep - or, in other words, in the whole field of the "non- naturals.”’
3. The Meaning of Sickness ‘For people in the past, illness experiences were far more likely to be charged with life meanings, involving and transforming ideas of self, salvation, destiny, providence, reward, and punishment. Sickness and sin, health and holiness were intimately linked, and it is worth remembering that the constant proximity of sickness and death was probably a great sustainer of the religious experience. Sickness cannot be seen in isolation; rather it is important to view responses to health and sickness as constitutive parts of whole cultural sets’.
4. The Importance of Lay Care ‘People took care before they took physick.’ Nowadays we tend to think of sickness and the other great bodily events as quintessentially individual, private experiences. That would be a mistake for communities in the past… we should never underestimate the key role of the family in sickness care and therapeutics in ages before doctors and welfare organizations were common. This is borne out by the vast quantities of family health-care manuals that cascaded off the presses. But the story of family medicine remains curiously neglected’.
Joan Lane: ‘The Doctor scolds me’. ‘A diary was...a repository of...secret hopes and fears...diarists included their medical problems, cures, unsuccessful or satisfactory treatments, opinions of medical practitioners and their advice...how they felt towards the whole experience of death, of being ill themselves or of tending an indisposed member of their family...an important aspect...is their unselfconsciousness’. ‘The purpose of letters was to inform one person distant from another about events’
Alice James (1848-1892) Sister of novelist Henry James and philosopher William James. Posthumously published diary kept in the last years of her life. Alice developed a complex of psychological and physical problems that eventually ended her life at age 43. She suffered several major breakdowns before her death from breast cancer. She sought various treatments for her disorders but never found significant relief.
Alfred Tennyson in a letter to fellow poet Edward FitzGerald, 1844. “I am in a Hydropathy Establishment in Cheltenham (the only one in England conducted on pure Priessnitzian principles). I have had four crises (one larger than had been seen for two or three years in Gräfenberg – indeed I believe the largest but one that has been seen). Much poison has come out of me, which no physic would have brought to light…I have been here already upwards of two months. Of all the uncomfortable ways of living surely the hydropathical is the worst: no reading by candlelight, no going near a fire, no tea, no coffee, perpetual wet sheet and cold bath and alteration from hot to cold: however I have much faith in it.”
Dr William Buchan (1729-1805) Author of Buchan's Domestic Medicine, a popular home encyclopedia published in 1769, which ran through many editions and sold 80,000 copies. In 'Death and Dr Hornbook', Robert Burns remarked that the Doctor had grown "weel acquaint wi' Buchan".
Mary Fissell, ‘The Disappearance of the Patient’s Narrative ’ ‘ The third Day after the Wether happened to be very warm he changed his Thick waistcot for a Linning one and being careless sat a quarter day in a Room that was wett the same evening he found himself not well and a little Feverish & thirsty for which he Went to Bed and Drank Plentifull of Sack Whey. The Next Morning he was very horse and out of order’ (1744) ‘His appearance was florid, his complexion clear. He complained of a light headache and a sore throat. His pulse was full and rather frequent, the tongue white, the tonsils slightly inflamed, the parotid glands were very much enlarged, the bowels were confined, and there was a little oppression about the chest’. (1816)
Nicholas Jewson, ‘The Disappearance of the Sick-Man’, Sociology (1976). Bedside Medicine: Early modern marketplace- competition Paying patient had a voice in the medical encounter Common language and concepts of health and illness Patient an individual Holistic approach- disease affected the whole organism Hospital Medicine: Post Revolution French hospitals- Paris Development of the construct of ‘the patient’ – ‘the clinical gaze’ Clinicians hold the power The patient became an object Disease located in specific organs Laboratory medicine: Late C19 German universities and research institutes Scientists hold the power Disease is located in cells
Conclusion Disappearance of the patient’s voice over time? Yes – more attention to physical signs, patient as object, move to clinic and lab - alienated from medicine? BUT patient’s voice never disappears
Bella Aronovitch, Give it Time. An Experience of Hospital 1928–32 (London, André Deutsch, 1974), pp. 38–74. “The result of this operation was absolute disaster. Within hours of it being performed the doctor had to remove the dressing because of the bleeding. There was some talk of my going up to the theatre again, which really reduced me to a state of terror, since I was vomiting badly as a result of the recent anaesthetic. The consultant came back twice to have a look at it and finally decided to leave it alone – to my great relief. About a week later when the sister was changing the dressing I plucked up enough courage to have a look at it and found it hard to believe that part of my body was also part of myself. The specialist, who was much given to puns and banter, kept up a running commentary with the house surgeon, the students and the nursing staff about this piece of surgery; somehow I found it very difficult to join in the fun. None of the sutures held and there was a gap of some three to four inches between one side of the incision and the other... I do not wish to go any further into the harrowing details, except to say my chances of getting better were almost nil. I became completely bedridden. I did not realize the enormity of what had happened for some time and still thought I would get better, though it might take longer. The behaviour of doctors and nurses towards the patient always seemed the same – that is, whatever happened to the patient was regarded as normal and in the natural order of things.”